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Aslan M, Sala M, Gueorguieva R, Garrison KA. A Network Analysis of Cigarette Craving. Nicotine Tob Res 2023; 25:1155-1163. [PMID: 36757093 PMCID: PMC10202645 DOI: 10.1093/ntr/ntad021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 01/25/2023] [Accepted: 02/06/2023] [Indexed: 05/24/2023]
Abstract
INTRODUCTION Craving is considered a central process to addictive behavior including cigarette smoking, although the clinical utility of craving relies on how it is defined and measured. Network analysis enables examining the network structure of craving symptoms, identifying the most central symptoms of cigarette craving, and improving our understanding of craving and its measurement. AIMS AND METHODS This study used network analysis to identify the central symptoms of self-reported cigarette craving as measured by the Craving Experience Questionnaire, which assesses both craving strength and craving frequency. Data were obtained from baseline of a randomized controlled trial of mindfulness training for smoking cessation. RESULTS The most central symptoms in an overall cigarette craving network were the frequency of imagining its smell, imagining its taste, and intrusive thoughts. The most central symptoms of both craving frequency and craving strength sub-networks were imagining its taste, the urge to have it, and intrusive thoughts. CONCLUSIONS The most central craving symptoms reported by individuals in treatment for cigarette smoking were from the frequency domain, demonstrating the value of assessing craving frequency along with craving strength. Central craving symptoms included multisensory imagery (taste, smell), intrusive thoughts, and urge, providing additional evidence that these symptoms may be important to consider in craving measurement and intervention. Findings provide insight into the symptoms that are central to craving, contributing to a better understanding of cigarette cravings, and suggesting potential targets for clinical interventions. IMPLICATIONS This study used network analysis to identify central symptoms of cigarette craving. Both craving frequency and strength were assessed. The most central symptoms of cigarette craving were related to craving frequency. Central symptoms included multisensory imagery, intrusive thoughts, and urge. Central symptoms might be targeted by smoking cessation treatment.
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Affiliation(s)
- Mihaela Aslan
- Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA CT Healthcare System, West Haven, CT, USA
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Margaret Sala
- Ferkauf Graduate School of Psychology, Yeshiva University, The Bronx, NY, USA
| | - Ralitza Gueorguieva
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
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Flanagan JC, Leone RM, Melkonian AJ, Jarnecke AM, Hogan JN, Massa AA. Effects of alcohol problem discrepancy on relationship adjustment: The moderating role of conflict negotiation among couples with alcohol use disorder and intimate partner violence. FAMILY PROCESS 2023. [PMID: 37148131 DOI: 10.1111/famp.12891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/12/2023] [Accepted: 04/12/2023] [Indexed: 05/07/2023]
Abstract
Alcohol use disorder (AUD) has well-known negative effects on romantic relationship functioning, including the occurrence of intimate partner violence (IPV). A separate literature focused on community couples indicates that relationship functioning is more likely to suffer when partners report greater discrepancies in alcohol consumption. It is important to expand this literature to couples with AUD and to examine the role of impactful AUD domains in dyadic functioning. Furthermore, few studies have examined adaptive, treatment-malleable factors that could potentially offset the negative impact of alcohol discrepancies on relationship functioning. This study examined the association between couples' alcohol problem discrepancies and relationship adjustment, as well as the moderating effect of self-reported adaptive conflict negotiation behaviors. Participants were 100 couples (N = 200 individual participants) with intimate partner violence wherein at least one partner met diagnostic criteria for AUD. Actor-Partner Interdependence Models indicated that greater alcohol problem discrepancy was associated with lower dyadic adjustment. Moderation analyses revealed that the highest level of relationship adjustment was observed among couples with lower alcohol problem discrepancy and greater negotiation behaviors, while relationship adjustment was similar for couples with larger alcohol problem discrepancy, regardless of negotiation behaviors. Although further study is needed to clarify under what specific conditions adaptive negotiation behaviors are most helpful, they appear to be beneficial for some couples in this sample. We found no evidence that negotiation behaviors may be harmful among these high-risk couples.
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Affiliation(s)
- Julianne C Flanagan
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina, USA
| | - Ruschelle M Leone
- Department of Health Policy & Behavioral Sciences and Mark Chaffin Center for Healthy Development, School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Alexander J Melkonian
- Department of Family Medicine, East Tennessee State University, Johnson City, Tennessee, USA
| | - Amber M Jarnecke
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jasara N Hogan
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Andrea A Massa
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina, USA
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Conlin WE, Hoffman M, Steinley D, Sher KJ. Cross-sectional and longitudinal AUD symptom networks: They tell different stories. Addict Behav 2022; 131:107333. [PMID: 35429920 DOI: 10.1016/j.addbeh.2022.107333] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/30/2022] [Accepted: 04/07/2022] [Indexed: 12/26/2022]
Abstract
Modern theoretical models of Alcohol Use Disorder (AUD) highlight the different functional roles played by various mechanisms associated with different symptoms. Symptom network models (SNMs) offer one approach to modeling AUD symptomatology in a way that could reflect these processes and provide important information on the progression and persistence of disorder. However, much of the research conducted using SNMs relies on cross-sectional data, which has raised questions regarding the extent they reflect dynamic processes. The current study aimed to (a) examine symptom networks of AUD and (b) compare the extent to which cross-sectional network models had similar structures and interpretations as longitudinal network models. 17,360 participants from Wave 1 (2001-2002) and Wave 2 (2003-2004) of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC) were used to model cross-sectional and longitudinal AUD symptom networks. The cross-sectional analyses demonstrate high replicability across waves and central symptoms consistent with other cross-sectional studies on addiction networks. The longitudinal network shared much less similarity than the cross-sectional networks and had a substantially different structure. Given the increasing attention given to the network perspective in psychopathology research, the results of this study raise concerns about interpreting cross-sectional symptom networks as representative of temporal changes occurring within a psychological disorder. We conclude that the psychological symptom network literature should be bolstered with additional research on longitudinal network models.
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Longitudinal network model of the co-development of temperament, executive functioning, and psychopathology symptoms in youth with and without ADHD. Dev Psychopathol 2021; 33:1803-1820. [DOI: 10.1017/s0954579421000900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
AbstractAttention-deficit hyperactivity disorder (ADHD) is a common, chronic, and impairing disorder, yet presentations of ADHD and clinical course are highly heterogeneous. Despite substantial research efforts, both (a) the secondary co-occurrence of ADHD and complicating additional clinical problems and (b) the developmental pathways leading toward or away from recovery through adolescence remain poorly understood. Resolving these requires accounting for transactional influences of a large number of features across development. Here, we applied a longitudinal cross-lagged panel network model to a multimodal, multilevel dataset in a well-characterized sample of 488 children (nADHD = 296) to test Research Domain Criteria initiative-inspired hypotheses about transdiagnostic risk. Network features included Diagnostic and Statistical Manual of Mental Disorders symptoms, trait-based ratings of emotional functioning (temperament), and performance-based measures of cognition. Results confirmed that ADHD symptom domains, temperamental irritability, and working memory are independent transdiagnostic risk factors for psychopathology based on their direct associations with other features across time. ADHD symptoms and working memory each had direct, independent associations with depression. Results also demonstrated tightly linked co-development of ADHD symptoms and temperamental irritability, consistent with the possibility that this type of anger dysregulation is a core feature that is co-expressed as part of the ADHD phenotype for some children.
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Rutten RJT, Broekman TG, Schippers GM, Schellekens AFA. Symptom networks in patients with substance use disorders. Drug Alcohol Depend 2021; 229:109080. [PMID: 34634562 DOI: 10.1016/j.drugalcdep.2021.109080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/25/2021] [Accepted: 09/11/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Reciprocity between symptoms of psychiatric disorders is increasingly recognized to contribute to their chronicity. In substance use disorders (SUD) little is known on reciprocal interactions between symptoms. We applied network analyses to study these interactions. METHODS We analyzed 11 DSM-IV / DSM-5 criteria for SUD for the most prevalent substances in addiction care (alcohol, cannabis, cocaine, stimulants, and opioids) in a sample of 10,832 SUD patients in treatment. First, we estimated an overall symptom network. Second, we compared symptom networks between the different substances. Finally, we tested differences in symptom networks between DSM-IV and DSM-5. RESULTS In the overall symptom network for SUD patients the most central symptom was: "spending substantial amount of the day obtaining, using, or recovering from substance use". The symptoms "giving up or cutting back on important activities because of use" and "repeated usage causes or contributes to an inability to meet important obligations", were the symptoms that influenced each other the most. Networks differed between substances both in global strength and structure, especially regarding the position of "use despite health or interpersonal problems". Networks based on DSM-5 criteria differed moderately from DSM-IV, mainly because "craving" was more central in the DSM-5 network than "legal problems" in DSM-IV. CONCLUSIONS Network analyses can identify core symptoms of SUD that could maintain the disease processes in SUD. Future studies should address whether targeting these core symptoms with precedence, might help to break through the addictive process.
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Affiliation(s)
- Ruud J T Rutten
- Tactus Centre for Addiction Treatment, Deventer, The Netherlands; Nijmegen Institute for Scientist Practitioners in Addiction, The Netherlands.
| | | | | | - Arnt F A Schellekens
- Nijmegen Institute for Scientist Practitioners in Addiction, The Netherlands; Radboud University Medical Centre, Donders Institute for Brain, Cognition, and Behavior, Department of Psychiatry, The Netherlands
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Ellingson JM, Ross JM, Winiger E, Stallings MC, Corley RP, Friedman NP, Hewitt JK, Tapert SF, Brown SA, Wall TL, Hopfer CJ. Familial factors may not explain the effect of moderate-to-heavy cannabis use on cognitive functioning in adolescents: a sibling-comparison study. Addiction 2021; 116:833-844. [PMID: 32881239 PMCID: PMC7925696 DOI: 10.1111/add.15207] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 03/23/2020] [Accepted: 07/20/2020] [Indexed: 01/16/2023]
Abstract
AIMS To examine whether moderate adolescent cannabis use has neurocognitive effects that are unexplained by familial confounds, which prior family-controlled studies may not have identified. DESIGN A quasi-experimental, sibling-comparison design was applied to a prospective, observational study of adolescents with moderate cannabis use. Participants were recruited from 2001 to 2006 (mean age = 17 years). A second wave of data was collected from 2008 to 2013 (mean age = 24 years). SETTING Two US metropolitan communities. PARTICIPANTS A total of 1192 adolescents from 596 families participated in this study. Participants were primarily male (64%) and racially and ethnically diverse (non-Hispanic white = 45%). A sibling in each family was a clinical proband identified due to delinquent behaviors. Whereas prior family-controlled studies have used samples of primarily infrequent cannabis users (mean = 1-2 days/month), participants here endorsed levels of cannabis use comparable to findings from epidemiological cohort studies (mean = 7-9 days/month). MEASUREMENTS Semi-structured clinical interviews assessed drug use, and a neuropsychological battery assessed cognitive abilities. Covariates included age at assessment, gender and alcohol use. FINDINGS After correcting for multiple testing, a greater frequency and earlier onset of regular cannabis use were associated with poorer cognitive performance, specifically on tests of verbal memory. Further, after accounting for familial factors shared by siblings and alcohol use, poorer verbal memory performance was still associated with greater life-time frequency of cannabis use at wave 1 [b = -0.007 (-0.002, -0.012), adjusted P = 0.036]; earlier cannabis use at wave 2 [b = -0.12 (-0.05, -0.19), adjusted P = 0.006; b = -0.14 (-0.06, -0.23), adjusted P = 0.006]; and greater frequency of past 6 months use at wave 2 [b = -0.02 (-0.01, -0.03), adjusted P = 0.002; b = -0.02 (-0.01, -0.03), adjusted P = 0.008]. CONCLUSIONS Moderate adolescent cannabis use may have adverse effects on cognitive functioning, specifically verbal memory, that cannot be explained by familial factors.
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Affiliation(s)
- Jarrod M. Ellingson
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado,Institute for Behavioral Genetics, University of Colorado Boulder,,Correspondence regarding this article should be sent to: Jarrod Ellingson, Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO 80045,
| | - J. Megan Ross
- Institute for Behavioral Genetics, University of Colorado Boulder
| | - Evan Winiger
- Institute for Behavioral Genetics, University of Colorado Boulder,,Department of Psychology and Neuroscience, University of Colorado Boulder
| | - Michael C. Stallings
- Institute for Behavioral Genetics, University of Colorado Boulder,,Department of Psychology and Neuroscience, University of Colorado Boulder
| | - Robin P. Corley
- Institute for Behavioral Genetics, University of Colorado Boulder
| | - Naomi P. Friedman
- Institute for Behavioral Genetics, University of Colorado Boulder,,Department of Psychology and Neuroscience, University of Colorado Boulder,,Institute for Cognitive Science, University of Colorado Boulder
| | - John K. Hewitt
- Institute for Behavioral Genetics, University of Colorado Boulder,,Department of Psychology and Neuroscience, University of Colorado Boulder
| | - Susan F. Tapert
- Department of Psychiatry, University of California San Diego, San Diego, California,Veterans Affairs San Diego Healthcare System, San Diego, California
| | - Sandra A. Brown
- Department of Psychiatry, University of California San Diego, San Diego, California,Veterans Affairs San Diego Healthcare System, San Diego, California
| | - Tamara L. Wall
- Department of Psychiatry, University of California San Diego, San Diego, California,Veterans Affairs San Diego Healthcare System, San Diego, California
| | - Christian J. Hopfer
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado,Institute for Behavioral Genetics, University of Colorado Boulder
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Funkhouser CJ, Chacko AA, Correa KA, Kaiser AJE, Shankman SA. Unique longitudinal relationships between symptoms of psychopathology in youth: A cross-lagged panel network analysis in the ABCD study. J Child Psychol Psychiatry 2021; 62:184-194. [PMID: 32399985 PMCID: PMC7657959 DOI: 10.1111/jcpp.13256] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/09/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND The network theory suggests that psychopathology may reflect causal relationships between individual symptoms. Several studies have examined cross-sectional relationships between individual symptoms in youth. However, these studies cannot address the directionality of the temporal relationships hypothesized by the network theory. Therefore, we estimated the longitudinal relationships between individual internalizing, externalizing, and attention symptoms in youth. METHODS Data from 4,093 youth participants in the Adolescent Brain Cognitive Development (ABCD) study were used. Symptoms were assessed using the Brief Problem Monitor, which was administered at three time points spaced six months apart. Unique longitudinal relationships between symptoms at T1 and T2 were estimated using cross-lagged panel network modeling. Network replicability was assessed by comparing this network to an identically estimated replication network of symptoms at T2 predicting symptoms at T3. RESULTS After controlling for all other symptoms and demographic covariates, depressed mood, inattention, and worry at T1 were most predictive of other symptoms at T2. In contrast, threats of violence and destructiveness at T2 were most prospectively predicted by other symptoms at T1. The reciprocal associations between depressed mood and worthlessness were among the strongest bivariate relationships in the network. Comparisons between the original network and the replication network (correlation between edge lists = .61; individual edge replicability = 64%-84%) suggested moderate replicability. CONCLUSIONS Although causal inferences are precluded by the observational design and methodological considerations, these findings demonstrate the directionality of relationships between individual symptoms in youth and highlight depressed mood, inattention, and worry as potential influencers of other symptoms.
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Affiliation(s)
- Carter J. Funkhouser
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Kelly A. Correa
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ariela J. E. Kaiser
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Stewart A. Shankman
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Goldberg JF, Siu C, Mao Y, Tsai J, Pikalov A, Calabrese JR, Loebel A. Major depressive disorder with mixed features and treatment response to lurasidone: A symptom network model. J Affect Disord 2020; 277:1045-1054. [PMID: 33065813 DOI: 10.1016/j.jad.2020.08.048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 06/07/2020] [Accepted: 08/20/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND To investigate the symptom network structure of major depressive disorder (MDD) with mixed features and implications for treatment. METHODS In this post-hoc analysis of a previously reported randomized trial, patients meeting DSM-IV-TR criteria for MDD presenting with two or three manic symptoms (DSM-5 mixed features specifier) were randomized to 6 weeks of double-blind treatment with lurasidone 20-60 mg/d (N = 109) or placebo (N = 100). The network structure of symptoms at baseline and their treatment moderating effects were investigated. RESULTS Network analyses showed that both ``elevated mood'' (YMRS item 1) and ``increased motor activity-energy'' (YMRS item 2) were associated with ``sleep disturbance'' ("bridge" symptom) and the depressive symptom cluster. Presence of both "elevated mood" and "increased motor activity-energy" at baseline predicted significantly less improvement in MADRS and CGI-S score at week 6 with lurasidone (vs. placebo) compared to patients without these manic symptoms at baseline. The network model also showed "rapid/pressured speech" (YMRS item 6) at baseline predicted improvement in both manic and depressive symptoms with lurasidone vs. placebo treatment. LIMITATIONS This was a post-hoc analysis where findings need to be confirmed by prospective controlled studies. CONCLUSIONS This post-hoc analysis describes the symptom network structure of MDD with mixed features in a patient sample at study baseline. Specific manic symptoms were found to be linked to sleep disturbance (characterized as a "bridge" symptom), which in turn linked the manic and depressive symptom clusters. The presence (vs. absence) of the specific manic symptoms we identified moderated the antidepressant and antimanic effects of lurasidone in the treatment of MDD with mixed (subthreshold hypomanic) features.
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Affiliation(s)
- Joseph F Goldberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY.
| | | | - Yongcai Mao
- Sunovion Pharmaceuticals Inc., Marlborough, MA and Fort Lee, NJ
| | - Joyce Tsai
- Sunovion Pharmaceuticals Inc., Marlborough, MA and Fort Lee, NJ
| | - Andrei Pikalov
- Sunovion Pharmaceuticals Inc., Marlborough, MA and Fort Lee, NJ
| | - Joseph R Calabrese
- University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Antony Loebel
- Sunovion Pharmaceuticals Inc., Marlborough, MA and Fort Lee, NJ
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Fonseca-Pedrero E, Ortuño-Sierra J, Inchausti F, Rodríguez-Testal JF, Debbané M. Beyond Clinical High-Risk State for Psychosis: The Network Structure of Multidimensional Psychosis Liability in Adolescents. Front Psychiatry 2019; 10:967. [PMID: 32116811 PMCID: PMC7026502 DOI: 10.3389/fpsyt.2019.00967] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 12/06/2019] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES The main goal of the present study was to analyze the network structure of schizotypy dimensions in a representative sample of adolescents from the general population. Moreover, the network structure between schizotypy, mental health difficulties, subjective well-being, bipolar-like experiences, suicide ideation and behavior, psychotic-like experiences, positive and negative affect, prosocial behavior, and IQ was analyzed. METHOD The study was conducted in a sample of 1,506 students selected by stratified random cluster sampling. The Oviedo Schizotypy Assessment Questionnaire, the Personal Wellbeing Index-School Children, the Paykel Suicide Scale, the Mood Disorder Questionnaire, the Strengths and Difficulties Questionnaire, the Prodromal Questionnaire-Brief, the Positive and Negative Affect Schedule for Children Shortened Version, and the Matrix Reasoning Test were used. RESULTS The estimated schizotypy network was interconnected. The most central nodes in terms of standardized Expected Influence (EI) were 'unusual perceptual experiences' and 'paranoid ideation'. Predictability ranged from 8.7% ('physical anhedonia') to 52.7% ('unusual perceptual experiences'). The average predictability was 36.27%, implying that substantial variability remained unexplained. For the multidimensional psychosis liability network predictability values ranged from 9% (estimated IQ) to 74.90% ('psychotic-like experiences'). The average predictability was 43.46%. The results of the stability and accuracy analysis indicated that all networks were accurately estimated. CONCLUSIONS The present paper points to the value of conceptualizing psychosis liability as a dynamic complex system of interacting cognitive, emotional, behavioral, and affective characteristics. In addition, provide new insights into the nature of the relationships between schizotypy, as index of psychosis liability, and the role played by risk and protective factors.
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Affiliation(s)
- Eduardo Fonseca-Pedrero
- Department of Educational Sciences, University of La Rioja, Logroño, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Oviedo, Spain.,Programa Riojano de Investigación en Salud Mental (PRISMA), Logroño, Spain
| | - Javier Ortuño-Sierra
- Department of Educational Sciences, University of La Rioja, Logroño, Spain.,Programa Riojano de Investigación en Salud Mental (PRISMA), Logroño, Spain
| | - Felix Inchausti
- Programa Riojano de Investigación en Salud Mental (PRISMA), Logroño, Spain.,Department of Mental Health, Servicio Riojano de Salud, Logroño, Spain
| | | | - Martin Debbané
- Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland.,Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
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